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Editor’s Note: This post is authored by Cor Dietvorst, Programme Officer at IRC. In his piece, Cor discusses the monitoring requirements surrounding India’s Swachh Bharat program, which Prime Minister Narendra Modi launched in October 2014 with the aim of ending open defecation in the country by 2019. He compares India’s sanitation monitoring initiative with other large-scale monitoring efforts with which IRC has been involved in Bangladesh and Indonesia. This post originally appeared here on the IRC blog.

Photo credit: Government of India

According to some media the Indian government has unleashed “toilet police” or “toilet gestapo” into the country.1 In fact, the central government has instructed local officials to take photographs of new toilets to prove that they have not only been constructed but are also being used. If states don’t upload photos by February 2015, the water and sanitation ministry has threatened to withhold funding from a new national sanitation programme.2

Open defecation free by 2019

Photo Credit: Swachh Bharat Mission Facebook

Prime Minister Narendra Modi launched the Swachh Bharat (Clean India) Mission on 2 October 2014. His aim is to attain a 100 percent open defecation free India by 2019. Since the launch, over half a million household toilets have been constructed.3

By implementing “real time monitoring” the government hopes it can correct past mistakes caused by ineffective monitoring and wasted investment in sanitation. The 2011 census revealed that 43% of government funded toilets were either “missing” or non-functional.4 Now the government wants to show that its investments in sanitation are delivering lasting results.

The Ministry of Drinking Water and Sanitation is appointing around two dozen additional staff including two joint secretaries and four directors to strengthen the implementation and monitoring of the Swachh Bharat Mission. An Expert Committee for innovative sanitation technologies and a national telephone helpline for rural water supply and sanitation are other new initiatives that will support the Mission.5

Smile please!

Local officials charged with monitoring toilet construction and use need to download an app on a mobile device. The app allows them to upload photos as well as the personal data and geo-coordinates of the beneficiaries to a public website. Progress is slow though: as of 14 January 2015, data of less than half a percent (2,383) of the newly constructed toilets has been recorded. Data collected before 2015 does not include toilet use.

Compared to examples of large-scale sanitation monitoring in Bangladesh and Indonesia, the toilet use indicators collected in India -- is the toilet in use, is it clean and is water available -- are rather limited.

The BRAC WASH programme in Bangladesh uses benchmark indicators developed by IRC for questions like: do all household members use toilets, do they use them at all times, and are there provisions for handwashing and pit emptying.6

In Indonesia IRC has helped design a monitoring system for the SHAW (Sanitation, Hygiene and Water) programme, where every three months 20,000 community volunteers visit more than 300,000 households. For SHAW monitoring is not merely an accountability tool as it is in India, but a way to motivate and encourage people to improve their sanitation facilities and hygiene behaviour.7

India's decision to track toilet use as part of its new monitoring initiative is a major step forward. From its neighbours, India can draw valuable lessons on how to monitor sanitation as a sustainable service that benefits all.

Launched as part of last month’s celebrations for World Toilet Day, the Toilet Board Coalition is a business-led initiative that aims to develop commercially scalable solutions in response to the global sanitation crisis.

Initiated by Unilever in 2012, the Toilet Board Coalition brings together a number of businesses, government agencies, and other WASH organizations. In addition to Unilever, Coalition members from the business sector include Kimberly Clark, LIXIL, and Firmenich, as well as other funders and NGOs such as Stone Family Foundation, WaterAid, Water and Sanitation for the Urban Poor (WSUP), and the World Bank’s Water and Sanitation Programme.

The Toilet Board Coalition brings together the technologies, expertise, and resources of its diverse membership to identify, develop, and scale market-based solutions in sanitation.

One pilot business model already supported by the Coalition is the Clean Team project, based in Ghana. The project, which is run by WSUP and uses toilets designed by Unilever, offers fee-based waste removal services that provide households with a cheap and clean alternative to public toilets while supporting the supply-side structure through the employment of sales and maintenance staff.

Editor’s Note: This guest post was authored by Leith Greenslade, Vice-Chair at the MDG Health Alliance, a special initiative of the Office of the United Nations Special Envoy for Financing the Health Millennium Development Goals. To coincide with the Global Day of Action for Child Survival, Leith writes about the relationship between toilets and childhood stunting, describing the scope of the problem and discussing the potential for improved sanitation through public-private partnerships. The original version of this post appeared here.

“Don’t ever, ever eat in the toilet!” When I grew up I imagined every mother in the world admonished her children with this warning. If you’ve grown up hearing this message, as so many children in middle and high income countries have, you simply cannot think of food and toilets in the same sentence without some discomfort. And yet it turns out the relationship between food and toilets is much more positive than our mothers ever led us to believe.

Quite simply, children who grow up in communities who use toilets are less likely to be malnourished and children who grow up in communities that defecate openly are much more likely to become what is called “stunted”, a horrible word that means much more than just being too short for your age and describes a condition that slows mental as well as physical development preventing children from reaching their full potentials.

How does the relationship between toilets and stunting work? The evidence is rolling in. Children who grow up surrounded by feces -- animal and human -- ingest it constantly which can trigger a disorder of the small intestine called “environmental enteropathy”. The intestinal walls of children who have this condition constantly "leak" bacteria into the blood stream causing chronic low-grade infections that consume vast amounts of energy to fight, leaving less nutrients available for growth.

Small problem?…Not exactly. An estimated 1 billion people practice open defecation globally and 165 million children are stunted, with the greatest concentrations of both in countries like India, Indonesia, Pakistan, Ethiopia, Nigeria, Sudan, Nepal, China, Niger, Burkina Faso, Mozambique and Cambodia. In these countries, open defecation and childhood stunting have enormous health and economic costs. Globally, they are major contributors to the 6.3 million child deaths that occur each year, most from infectious diseases such as pneumonia and diarrhea, cost hundreds of billions of dollars in medical treatment for those who get sick, and significantly depress economic growth and development.

India is the eye of the storm with the world’s highest concentrations of open defecation (600 million), stunted children (62 million) and child deaths (1.3 million). To accelerate investments in reducing open defecation and improving child nutrition in India, the United Nations Foundation, the MDG Health Alliance and WASH Advocates co-hosted a discussion in September with leading experts to explore how public-private partnerships could tackle the sanitation/nutrition challenge in a more integrated way.

Participants included the Public Health Foundation of India’s Ramanan Laxminarayan, UNICEF’s Sanjay Wijesekera, Jean Humphrey from Johns Hopkins School of Public Health, Analia Mendez of Unilever, Lucy Sullivan from the 1000 Days Initiative, and Gardiner Harris from the New York Times, whose scathing article on the lack of access to toilets in India inspired the conversation. The discussion was in support of the UN Secretary-General’s Every Woman Every Childmovement.

The panel acknowledged that food interventions alone can close only about a third of the average growth deficit of Asian and African children and that the global development community has substantially underestimated the contribution of sanitation and hygiene to childhood growth. Although there was agreement that increasing access to locally designed, manufactured and marketed toilets in participation with the private sector is a critical part of the solution (with Jim McHale from American Standard sharing details of their success in Bangladesh with the SaTo toilet and Analia Mendez outlining Unilever’s new Uniloo project), the panel argued for a big push to increase demand for toilets.

Gardiner Harris cited the recent SQUAT survey that revealed a strong preference for open defecation among older males in India and the work of the Rice Institute’s Dean Spears which shows that Hindus are 40% more likely than Muslims to practice open defecation, a factor that accounts for the large (18%) child mortality gap between Hindus and Muslims. Experts agreed education efforts and incentives to encourage toilet use should target the sub-populations most resistant to change.

Despite barriers on both the demand and supply sides, panelists acknowledged that political commitment for ending open defecation has never been stronger. At the global level the United Nations Deputy Secretary-General, Jan Eliasson, is leading the End Open Defecation campaign and the Indian Prime Minister, Narendra Modi, announced the Swachh Bharat Mission with the goal of ending open defecation in India by 2019, to coincide with Mahatma Gandhi’s 150th birthday. There is now an opportunity for other stakeholders, especially the private sector, to fully engage with these public partners to drive down open defecation rates and simultaneously invest in child nutrition interventions. By delivering sanitation and nutrition investments together to the largest populations of children living in the open defecation communities, the deaths of many more children could be prevented and the lifelong impacts of stunting dramatically reduced.

Almost fifteen years ago the Millennium Development Goals (MDGs) set out to halve child hunger, reduce child deaths by two thirds and double access to toilets. With just 450 days left until the MDG deadline, the world has managed to reduce childhood stunting by 35%, child mortality by 50%, and those without basic sanitation by 30% -- impressive, but not enough to achieve the targets. In the time remaining, we need to pull out all stops to build new public-private partnerships to invest aggressively in integrated sanitation and nutrition solutions prioritizing the largest populations of children who grow up constantly exposed to feces.

Editor’s Note: This post is authored by Sanjay Banka, Director at Banka BioLoo, an Indian company that manufactures and promotes biodigester toilets for use in parts of the country where the lack of infrastructure prevents the use of more conventional sanitation facilities. In the piece, Sanjay discusses the development of the biotechnology used in the toilets and describes the successes and challenges that the company has experienced while working to improve sanitation in India.

Sanitation facilities in India are alarmingly poor with over 600 million people (half of India's population) having no access to toilets. This lack of access, coupled with other inadequacies in waste disposal, such as the Indian Railways’s open-chute toilet system wherein human waste drops on the rail tracks, poses health hazards, raises environmental concerns, and leads to water contamination.

To address India’s sanitation problems, the government, NGOs, non-profit organizations, donor agencies, development bodies, and the private sector have been working in their own way, often with very little concerted effort. The partnership between India’s Defence Research and Development Organization (DRDO) and Banka BioLoo, however, provides one example of how cross-sector collaboration can work to provide sanitation solutions. Using technology developed and licensed by the DRDO, the R&D arm of the Indian Ministry of Defence, Banka BioLoo is working to meet the need for basic, easy-to-install and hygienic human waste disposal mechanisms in areas without sewerage and other sanitation infrastructure.

The DRDO had been grappling with the challenge of managing and treating the fecal matter of its defence personnel. After several years of research, the Organization developed a set of bacteria that “eat away” at human waste. Having successfully used these bacteria to treat the night soil of soldiers guarding the Indian borders, in 2010, the DRDO decided to extend the benefits of the technology to the civilian population by licensing the bio-technology to commercial firms. A host of businesses, including Banka BioLoo, signed the transfer of technology. Since then, Banka BioLoo has developed the necessary infrastructure to inoculate the bacteria and has built a business model that positions bio-toilets as a cost-effective and environmentally-friendly sanitation solution.

Bio-digester technology treats human waste at the source. A collection of anaerobic bacteria that has been adapted to work at temperatures as low as -5°C and as high as 50°C act as inocula (seed material) to the bio-digesters and convert the organic human waste into water, methane, and carbon-dioxide. The anaerobic process inactivates the pathogens responsible for water-borne diseases and treats the fecal matter without the use of an external energy source.

The only by-products of the waste treatment process are pathogen-free water, which is good for gardening, and biogas, which can be used for cooking. Bio-toilets do not require sewage connectivity and because the process is self-contained, bio-toilets are also maintenance-free. While we explain the functioning of the system to users, no specific training is required.

A bio-tank, which is placed beneath the toilet structure and holds the bio-digester bacteria, is installed in Hyderabad. Credit: Banka BioLoo

Banka BioLoo employs a for-profit model in distributing its bio-toilets. This approach is consistent with the thinking that came up in discussion recently at the 2014 WASH Sustainability Forum in Amsterdam, where it was recognized that many households are able and willing to pay for good quality sanitation services. Unfortunately, many are being offered cheap and possibly sub-standard systems. As solution providers, we need to be wary of poor quality “solutions” and instead appeal to the aesthetic and aspirational needs of society. While affordability is certainly an issue, it should not come at the cost of developing a sub-par product.

While we strongly believe in the for-profit model to help ensure sustainability, we are also looking for alternate financing options for households that are unable to pay for the toilet outright. We are in discussion with government agencies and microfinance institutions to develop programs that would provide subsidies or microloans to consumers.

Banka BioLoo has also worked with charities and other development organizations to provide bio-toilets in underserved areas. In March 2013, some members of the student chapter of Engineers Without Borders (EWB), studying in Gitam University, decided to undertake a project to help provide sanitation facilities in Rudraram village, at the outskirts of Hyderabad in southern India. Using a combination of student efforts, input from family members, sponsored funds, and contributions from user families, Banka BioLoo, in partnership with EWB, installed five bio-toilets. In 2014, the project provided bio-toilets to 20 additional families. The student community is keen to develop a 10-kilometer radius around the university as an open defecation free area.

One remaining challenge in promoting the use of the toilets involves the perception among some Indians that sanitation is not worth paying for. Many are comfortable with defecating in the open. In promoting the bio-toilets, we explain the negative effects on the health and well-being of society -- particularly women and children -- that are associated with open defecation. As this understanding continues to develop in India, the demand for sanitation products, such as the bio-toilets, will grow. We are actively working in this direction, trying to provide economical and eco-friendly sanitation systems for all -- from the most marginalized populations to large institutions and corporations across various states in India -- while building up the good reputation of the latrine.

Earlier this month, the Sanitation and Water for All (SWA) High Level Meeting (HLM) was hosted by the World Bank in Washington, D.C. The partnership’s third convening -- watched closely by those involved in the WASH sector -- brought together ministers of finance, health, and WASH from developing countries, as well as donors and other development partners to discuss specific commitments to achieve universal access to clean water and adequate sanitation.

An important outcome of the HLM was the endorsement of 265 new commitments addressing a range of issues in WASH -- from increasing the availability and efficiency of financial resources, to improving access to services and strengthening the institutions responsible for the delivery of water and sanitation.

In a short video report posted to SWA’s website, Barbara Frost, Chief Executive of WaterAid, discusses her impressions of the meeting and lauds the group’s open dialogue about sector-wide challenges -- such as addressing donor fragmentation and balancing the involvement of the private sector with the human right to water.

A webcast from the 2014 meeting has also been made available on the World Bank’s website.

Six organizations were awarded grants totaling $2 million to develop innovative "next-generation toilets" that can deliver safe, affordable, and sustainable sanitation solutions in India. A collaboration between the Gates Foundation, BIRAC, and the Indian Ministry of Science and Technology, the competition is funded by investments of $1 million each from the Gates Foundation and the ministry's Department of Biotechnology.

Announced at the "Reinvent the Toilet Fair: India" in New Delhi, the grant recipients are Eram Scientific Solutions, which, in partnership with the University of South Florida, will field test a solar-powered modular electronic toilet that is integrated with a mixed-waste processing unit; the Amrita School of Biotechnology, which will test the use of viral agents to kill pathogens and odor-producing bacteria in fecal waste; Pradin Technologies, which will test the viability of using ultrasound to reduce water use in toilets; the Indian Institute of Technology Roorkee, which, in partnership with Fresh Rooms Life Sciences, will develop a single-household container that uses human feces to incubate black soldier fly larvae, which can be processed into marketable products; the Institute of Chemical Technology, which will evaluate the concept of using fine sand-like material and an air blower to create a water-free toilet interface free of odor and flies; and BITS Pilani K.K. Birla Goa Campus, which, in partnership with Ghent University and Sustainable Biosolutions, will design a septic tank that uses electrochemistry to reduce organic pollutants and improve the quality of discharged effluent.

"Effective and comprehensive sanitation seems an impossible dream for India," said BIRAC chair K. Vijay Raghavan. "Yet today we see a congruence of new and applicable science and technology, its affordability, and sustainable implementation. This congruence is a great opportunity, which we cannot afford to let slip. By implementing effective solutions in each kind of social context, big problems can be dealt with in small units and be catalysts for scaling up."

The Gates Foundation also announced a partnership with South Africa's Department of Science and Technology to field test technologies developed as part of the global Reinvent the Toilet Challenge. The foundation and DST will invest $1 million and approximately $2.76 million (30 million rand), respectively, in the effort.

"By applying creative thinking and new approaches to sanitation challenges, we can improve people's lives. And we have no doubt that these new partnerships with India and South Africa will help us achieve this," said Brian Arbogast, director of the Water, Sanitation & Hygiene team at the Gates Foundation. "We believe that with governmental leadership, new business models, and innovation, we can dramatically increase the progress made in tackling this global sanitation crisis."

Created in 2013 with $15 million from the Gates Foundation and administered by ADB, the fund will leverage more than $28 million in financing over the next five years for non-sewered sanitation and septage management projects across Asia. Grants announced by the fund include $2 million for ADB’s Facility for Pilot and Demonstration Activity, which will test and validate pilot approaches to new sanitation management and water services delivery policies, technologies, and business models, with the goal of replicating and scaling successful approaches across the region; and $1.6 million for pilot innovations in septage collection and treatment systems in eight coastal towns in Bangladesh. Part of a planned ADB loan to Bangladesh for infrastructure improvements, the grant also will support efforts to improve septage operation and maintenance, and to promote private-sector participation in septage management.

In addition, the fund awarded a grant to the South Asia Urban Knowledge Hub (k-hub), a network of four research and training institutions in Bangladesh, India, Nepal, and Sri Lanka supported by ADB that works to facilitate information and learning exchange among city managers, utility staff, policy makers, academics, and the private sector.

"We will continue to work with the governments in Asia-Pacific region to make countries open defecation-free and complement their efforts by providing options for small-scale sanitation systems in urban and rural communities," said Amy Leung, director of the Urban Development and Water Division in ADB's Southeast Asia Department. "We are proud to support new testing and pilot implementation of innovative solutions to hasten access to safe sanitation for Asia’s urban poor."

"Open defecation and inadequate toilets, sewers, and wastewater treatment systems lead to massive amounts of untreated human waste in the environment, harming the health and well-being of children," said Brian Arbogast, director of the Water, Sanitation & Hygiene team at the Gates Foundation. "We are delighted to have new partners like the ADB applying creative thinking to more effectively managing human waste to improve people’s lives."

The organization will use the grant to support initiatives to increase access to basic sanitation services led by the governments of Ghana, India, and Senegal. In addition, the funds will be used to help ensure that the United States, the world's largest donor country, supports improved accountability and data collection with respect to WASH efforts in those countries and is focused on solutions that highlight the linkages between sanitation and other health efforts, including improved nutrition and ending preventable child deaths.

"Investing in advocacy around toilets and sanitation is one of the smartest, most effective ways we have to combat extreme poverty," said WaterAid America CEO David Winder. "Health, quality of life, and poverty levels are radically impacted when people, especially women and girls, have access to toilets and hygiene education."

According to the World Health Organization, an estimated $220 billion would be returned to the global economy each year if the world were to achieve universal access to sanitation. Development aid for toilets and sanitation, however, is significantly less relative to other development sectors such as health and education.

"The sanitation crisis cannot be solved by any one organization alone," said Lisa Schechtman, WaterAid America's director of policy and advocacy. "WaterAid firmly believes that governments have a responsibility to their citizens to ensure that toilets and sanitation are available to everyone. We look forward to continuing to advocate for change exactly where it’s needed most."

Editor’s Note: We pose five questions to foundation, NGO, and thought leaders in the WASH sector as part of our “5 Questions for…” series. In this post, David Auerbach, co-founder of Sanergy, shares his thoughts on the sanitation value chain, community ownership, and exciting innovations in sanitation in response to our questions.

1. What is the number one most critical issue facing the WASH sector today?

The most critical issue that the WASH sector faces is the lack of systems-based thinking. We need to go beyond simply providing a toilet. Although 2.5 billion people lack access to a clean toilet, 4.1 billion are at risk because sewage is not treated. At Sanergy, we take a systems-based approach that addresses the entire sanitation value chain. We provide clean toilets through a franchise network of local micro-entrepreneurs, collect the waste professionally, and treat it properly by converting it into useful byproducts, such as organic fertilizer. Failure to address the whole chain ultimately pushes the challenge further downstream.

2. Tell us about one collaboration or partnership your organization undertook and the lessons learned from that experience.

Sanergy sells Fresh Life Toilets to local micro-entrepreneurs. The franchise package includes installation, marketing, training and business support, and a daily waste collection service, and costs about $600 for the first year. In our work with the residents of Nairobi’s slums, we came across micro-entrepreneurs who were excited to launch Fresh Life businesses -- especially women and youth -- but who did not have immediate access to finance to start up their businesses. Kiva, an online micro-lending platform, partnered with us to provide 0% interest loans to future Fresh Life Operators. The partnership has led to 73 loans being issued and the construction of over 120 Fresh Life Toilets. Those operators serve 5,000 residents with hygienic sanitation daily. At the same time, Kiva gives us an incredible platform to share the resilient, compelling stories of our micro-entrepreneurs with the world.

By partnering with Kiva, we are overcoming an important hurdle -- access to finance -- and are creating a grassroots, sustainable solution to provide critical sanitation services.

3. How do you work with local communities to promote project ownership and sustainability?

All 161 of our Fresh Life Operators -- each of whom has invested their own savings in Fresh Life -- are from the Mukuru community. They are critical to the sustenance of our business and are key players in effectively tackling the sanitation crisis. One such operator is Agnes Kwamboka who has a remarkable story of the transformation that she was able to make as a partner with Fresh Life. Tired of having to bribe policemen so that she could run her unregulated brew business, she closed it down and had two Fresh Life Toilets installed. Now, she earns a good income, which enables her to sustain her family and no longer worry about the police. She has also reinvested the profits by purchasing additional Fresh Life Toilets and in literacy classes for herself. Testimonies like these show that we are positively changing the community and changing people’s mindsets about their role in society.

The other significant way in which we gain community buy-in is by hiring from the community. Sixty percent of our 135-person team is from the local community and over 60% of our staff is between 18 – 25 years old -- the age bracket with the highest unemployment in Kenya. The residents know how the lack of adequate sanitation can have disastrous effects on their lives and this makes them extra-determined to change their communities for the better.

Fresh life toilets become part of the landscape in the informal settlements in which Sanergy works. Credit: Sanergy

4. Tell us about an emerging technology or solution that excites you and that you think will make a big impact in the WASH sector over the next 5-10 years.

One great initiative to emerge is the Bill & Melinda Gates Foundation’s Re-invent the Toilet Challenge (RTTC). Institutions and researchers have received generous grants to come up with innovative approaches for the hygienic provision, collection and treatment of waste. The initiative has really catalyzed the entire sector and, moreover, broken down taboos to bring the sanitation challenge to the center of any development conversation. Through the RTTC, Sanergy has benefited significantly. We have partnered with The Climate Foundation to develop biochar -- an organic soil conditioner. We have worked closely with Agriprotein in South Africa to develop a protein-rich animal feed made from maggots that consume only human waste. These technologies have the potential to be massively important for the agricultural input industries. In creating value from waste, we give incentive for everyone to participate in the sanitation value chain.

Lately, we have read a couple of compelling papers from the World Bank’s Water and Sanitation Program about what a toilet’s worth, from ID Insight about IDE-Cambodia’s work with microfinance, and Dean Spears’ research on the effect a lack of hygienic sanitation has on children’s height.

The Bill & Melinda Gates Foundation and the Asian Development Bank (ADB) have partnered to set up a joint trust fund to improve access to sanitation in Asia and the Pacific. Announced at World Water Week, the new Sanitation Financing Partnership Trust Fund will receive a $15 million investment from the Gates Foundation and will leverage more than $28 million in investments from ADB by 2017.

The Trust Fund aims to increase non-sewered sanitation and develop septage management solutions through funding innovative projects and supporting policies for low-income urban communities across Asia. The Trust Fund will be part of ADB’s Water Financing Partnership Facility (WFPF). Over the last seven years, WFPF has invested $2.5 billion in WASH projects. Through initiatives such as Grand Challenges Exploration and Reinvent the Toilet Challenge, the Gates Foundation has funded 85 development and research projects on sanitation.